Saturday, September 13, 2014

Medicare says "That's our story and we're sticking to it"


Late last evening I opened an envelope from the Centers for Medicare and Medicaid Services (CMS). It contained an obvious boilerplate letter (tipoff: the date is rubber stamped) from Laurence Wilson, Director, Chronic Care Policy Group.

In this letter, Mr. Wilson repeats verbatim, what has obviously become the CMS official statement on the SGD issue. The same statement that was attributed to Aaron Albright in the September 2nd edition of the Washington Post and, in part, says: "Medicare has covered speech-generating devices since 2001, which greatly improve the day-to-day lives of many beneficiaries. This policy has not changed, nor have we proposed this coverage to change."

This is very clever wording. Something that seems to have been lost on advocates for the disabled in the heat of battle is that CMS is correct when it states they haven't changed any rules. That's the grain of truth which makes makes any Big Lie effective. Remember, the document that started the uproar, issued by CMS on February 27th of this year, was a Coverage Reminder. The obfuscation is, they are changing the way they administer the existing rules. Baseball fans and players understand the frustration of an umpire who shortens the strike zone in the 7th inning. That's effectively what CMS has done with this Coverage Reminder. They've put Medicare beneficiaries, DME suppliers and SGD manufacturers on notice that they are changing the strike zone. The problem is, this isn't a game.

(NOTE: Many argue that by reclassifying SGD's to the "capped rental" category of Durable Medical Equipment (DME) from the "fully purchased" category constitutes a rule change. We think so, and CMS disagrees (to no surprise). The issue of how SGD's are paid for was not addressed in the February 27th Coverage Reminder so we are not addressing that issue in this article.)

By changing the way CMS administers the rules, they are placing thousands of speech impaired people at risk of social isolation, not being able to effectively communicate their wishes to medical staff and family and have restricted beneficiaries, in this age of Facebook, Twitter, Instagram and texting, to only face-to-face communication. And the irony is, CMS never paid for these added "frills" - ever. It was always paid for by the beneficiaries out of pocket.

In a letter delivered to CMS yesterday, and signed by 27 Senators and almost 200 House members, the closing paragraph begins: "The patients who are in need of SGD's are some of Medicare's most vulnerable beneficiaries." Very true. And CMS has inexplicably changed the strike zone, ignored pleas from Congress and, to be kind, they are now artfully weaving a fictitious story line which flies in the face of reality.

Why? I'm becoming more convinced with each passing day, it's one of two things:

1.  It's just an enormous bureaucracy run amok and too proud to admit it's messed up, or

2.  It's an attempt to pass costs on to beneficiaries.

If it's number 2, taking into consideration the Congressional sentiment that CMS' decisions attack the most vulnerable among us, shame on them.


An article from today's The Hill:




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